DocumentReference Usage for PDF Writebacks in Epic via SMART on FHIR

[Vijash T]

We have a SMART on FHIR (SOF) application that performs a DocumentReference write back to Epic for a given encounter. The DocumentReference includes a PDF attachment that contains a mix of:

·       Medication information from the encounter

·       Discount details (e.g., copay assistance) for pharmacy use

We are looking for guidance on what’s possible and considered best practice within Epic’s FHIR ecosystem.

Questions:

·       Viewing in eRX Systems

o   Is it possible for an eRX system integrated with Epic to view or access the DocumentReference PDF?

o   If yes, what configuration is required to enable this?

·       Inclusion in Discharge Summary

o   Is there a workflow or configuration in Epic that allows a DocumentReference (with PDF) to be included as part of the discharge summary?

o   Can this attachment be printed or viewed during discharge workflows?

·       LOINC Code Mapping for Mixed Content

o   We are currently using LOINC code 11506-3 (Progress Note) for the DocumentReference.

o   Since the PDF includes both clinical content (medications) and financial content (discount codes):

§  Would it be more appropriate to use a Discharge Summary LOINC code instead?

§  Are there any known Epic restrictions or best practices when mapping LOINC codes for such mixed content?